OMB Number: 0980-0204 Expiration Date: 12/31/2009 Project Abstract Summary Program Announcement (CFDA) Program Announcement (Funding Opportunity Number) CDC-RFA-DD09-901 Closing Date 07/06/2009 'Applicant Name The American Society Of Human Genetics 'Length of Proposed Project 48 Application Control No. Federal Share Requested (for each year) * Federal Share 1st Year * Federal Share 2nd Year $ 116,140 $ 118,390 * Federal Share 4th Year * Federal Share 5th Year $ 123,030 $ Non-Federal Share Requested (for each year) * Non-Federal Share 1st Year * Non-Federal Share 2nd Year 5,405 5,567 * Non-Federal Share 4th Year * Non-Federal Share 5th Year $1; 5,906 * Project Title American Society of Human Genetics Pioblic Health Genetics Fellowship * Federal Share 3rd Year 120,686 * Non-Federal Share 3rd Year 5,734 OMB Number: 0980-0204 Expiration Date: 12/31/2009 Project Abstract Summary * Project Summary The Public Health Genetics Fellowship Program is a collaboration between the American Society of Human Genetics (ASHG) and the Centers for Disease Control and Prevention (CDC)to train highly qualified genetics professional in the arena of public health genetics and genomics. ASHG and CDC will provide senior staff members to serve as co-directors and mentors for the program. Candidates will be actively recruited from the largest pool of genetics professionals available, and selected jointly by the two collaborating organizations. The Program will train fellows in methods to do research and translate those findings into public health situations and practice. The fellows will be provided opportunities to present their work, with or without supervision (As appropriate) at national and international meetings, to submit articles for peer-reviewed journals, and to participate in genetics and public health policy and research forums and meetings, including committee appointments whenever feasible. This application is a continuation of CDC Program established under PA 04059, which has trained four fellows who have achieved successful placements in organizations and universities to utilized their expanded skills. Two current fellows are in the program and will also find competitive placements based on their successful coirpletion of the program. * Estimated number of people to t>e served as a result of the av/ard of this grant 100000 DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 2. * Status of Federal Action: I I a. bid/offer/application [X] b. initial award I I c. post-award Entity: 1. * Type of Federal Action: a. contract X b. grant c. cooperative agreement d. loan e. loan guarantee f. loan insurance 4. Name and Address of Reporting [X] Prime | [SubAwardee American Society of Human Genetics- * S(ree/1 9650 Rockville Pike [unreadable]City NOT A LOBBY ORGANIZATION State MD: Maryland Congressional District, if laiown;MD Bth 5. If Reporting Entity in No.4 is Subawardee, Enter 6. * Federal Department/Agency: 8. Federal Action Number, if known: 10. a. Name and Address of Lobbying Registrant: Prefix * Last Name Boughman [unreadable] Street 1 [unreadable]City State Name and Address of Prime: Approved by OMB 31 U.S.C.1352 0348-0046 * Report Type: |X| a- initial filing j [ b. material change Zip 7. * Federal Program Name/Description: CFDA Number, if applicable: 9. Award Amount, if known: $ Middle Name SufHx Zip b. Individual Performing Services (including address if different from No.lOa) Prefix [unreadable] First Name Middle Name 'Lasr Name Suffix Boughman [unreadable] Street 1 Street 2 [unreadable]City State Zip "I <\ Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when the transaction was made or entered Into. This disclosure Is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Inspection. Any person who falls to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Signature;completed on submission to Grants.gov *Name: Prefix [unreadable] First Name Middle Name 'l-ast Name Suffix Boughman TItie: Executive Vice President Telephone No.: 301 634 7307 Date: completed on submission to Grants.gov [unreadable]*-[unreadable] r,,'1--I ^O'-. '-',. ->^,[unreadable]. ^-.j-'i',-," Authorized for L.ocal Reproduction .Federa"IUse.0n!yw".'i-~i-''i'**-,','[unreadable].[unreadable]<'":[unreadable]" [unreadable][unreadable]t'". -. 4^-: [unreadable][unreadable][unreadable] i [unreadable] ,',,'[unreadable])', '[unreadable], .'Stendopd Form [unreadable] LLL (Rev. 7-97) Grant Program Catalog of Federal Function or Domestic Assistance Activity Number (a) (b) Public Health 1. Genetics Fellowship Program 2. Ptjblic Health Genetics Fellowship Program Public Health 3. Genetics Fellowship Program Public Health 4. Genetics Fellowship Program 5. Totals OMB Approval No. 4040-0006 BUDGET INFORMATION - Non-Construction Programs Expiration Date 07/30/2010 SECTION A - BUDGET SUMMARY Estimated Unobligated Funds New or Revised Budget Federal Non-Federal Federal Non-Federal Total (c) (d) (e) (f) (g) $ 116,140.00 $ 2,800.Ool $ $ $ 118,940.00 - 118,390.00 2,900.00 121,290.00 120,686.00 3,100.00 123,786.00 123,030.00 3,300.00 126,330.00 $ 478,246.00 $ 12,100.00 $ $ $ 490,346.00 Standard Form 424A (Rev. 7- 97) Prescribed by OMB (Circular A-102) Page 1 6. Object Class Categories a. Personnel b. Fringe Benefits c. Travel d. Equipment e. Supplies f. Contractual g. Construction h. Other i. Total Direct Charges (sum of 6a-6h) j. Indirect Charges k. TOTALS (sum of 61 and 6j) 7. Program Income SECTION B - BUDGET CATEGORIES Gi^NT PROGRAM, FUNCTION OR ACTIVlPi'Total (1) (2) (3) (4) (5) Public Health Public Health Public Health Public Health Genetics Fellowship Genetics Fellowship Genetics Fellowship Genetics Fellowship Program Program Program Program $ 5,500.00 $ 5,665.00 $ 5,835.00 $ 6,010.00 $ 23,010.00 1,540.00 1,587.00 1,634.00 1,683.00 6,444.00 5,000.00 5,000.00 5,000.00 5,000.00 20,000.00 0.00 0.00 0.00 0.00 500.00 500.00 500.00 500.00 2,000.00 101,900.00 103,938.00 106,017.00 108,137.00 419,992.00 0.00 0.00 0.00 0.00 . 1,700.00 1,700.00 1,700.00 1,700.00 6,800.00 116,140.00 118,390.00 120,686.00 123,030.00 $ 478,246.00 0.00 0.00 $ $ 116,140.00 $ 118,390.00 $ 120,686.00 $ 123,030.00 $ 478,246.00 $ $ $ $ $ Authorized Reproduction Standard Form 424A (Rev. 7- 97) Prescribed by OMB (Circular A -102) Page 1A for Local SECTION (a) Grant Program public Health Genetics Fellowship Program 8. Public Health Genetics Fellowship Program 9. public Health Genetics Fellowship Program , 10. Public Health Genetics Fellowship Program 11. C - NON-FEDERAL RESOURCES (b) Applicant (c)State (d) Other Sources (e)TOTALS $ 5,405.00 $ $ $ 5,405.00 5,568.00 5,568.00 5,735.00 5,735.00 5,405.00 5,405.00 12. TOTAL (sum of lines 8-11) $ 22,113.00 $ $ $ 22,113.00 SECTION D - FORECASTED CASH NEEDS Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter 13. Federal $ 116,140.00 $ 29,035.00 $ 29,035.ool $ 29,035.00 $ 29,035.00 14. Non-Federal $ 5,405.00 1,352.00 1,352.00 1,350.00 1,351.00 15. TOTAL (sum of lines 13 and 14) $ 121,545.00 $ 30,387.00 $ 30,387.00 $ 30,385.00 $ 30,386.00 SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT (a) Grant Program FUTURE FUNDING PERIODS (YEARS) (b)First (c) Second (d) Third (e) Fourth public Health Genetics Fellowship Program 16. $ 29,035.00 $ 29,597.00 $ 30,171.00 $ 30,757.ool 17. public Health Genetics Fellowship Program 18. public Health Genetics Fellowship Program public Health Genetics Fellowship Program 19. 20. TOTAL (sum of lines 16 - 19) 21. Direct Charges: 478,246 23. Remarks: The contractual relationship is 29,035.00 29,598.00 30,172.00 30,758.00 29,035.00 29,597.00 30,171.00 30,757.00 29,035.00 $ 116,140.00 $ SECTION F - OTHER BUDGET INFORMATION 22. Indirect Charges: 0 established directly with the fellow, as the fellow is serving Authorized for Local Reproduction 29,598.00 30,172.00 30,758.00 118,390.00 $ 120,686.00 $ 123,030.00 off-site from the applicants offices. standard Form 424A (Rev. 7- 97) Prescribed by OMB (Circular A -102) Page 2 [unreadable]PHS-5161-1 (7/00) CHECKLIST OMB Approval No. 0920-0428 Public Burden Statement: Clearance Officer, 1600 Clifton Road, MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0428). Do not send the completed form to this address. Public reporting burden of this collection of information is estinnated to average 4 hours per response, including the time for reviewing instructions, searching NOTE TO APPLICANT: existing data sources, gathering and nnaintaining the data needed, and completing and reviewing the collection of infonnation. An agency may not This form must be completed and submitted with the original of your conduct or sponsor, and a person is not required to respond to a collection of application. Be sure to complete both sides of this form. Checl^ the information unless it displays a cun-ently valid OiWB control number. Send appropriate boxes and provide the information requested. This form should be comments regarding this burden estimate or any other aspect of this attached as the last age of the signed original of the application. This page is collection of information, including suggestions for reducing this burden to CDC, reserved for PHS staff use only. Type of Application: I NEW [^ Noncompeting Continuation [] Competing Continuation [^ Supplemental PART A: The following checklist is provided to assure that proper signatures, assurances, and certifications have been submitted. Included NOT Applicable 1. Proper Signature and Date 2. Proper Signature and Date on PHS-5161-1 "Certifications" page [unreadable] 3. Proper Signature and Date on appropriate "Assurances" page, i.e., SF-424B (Non-Constmction Programs) or SF-424D (Constmction Programs) 4. If your organization currently has on file with DHHS the following assurances, please identify which have been filed by indicating the date of such filing on the line provided. (All four have been consolidated into a single fonm, HHS Fonm 690) [unreadable] Civil Rights Assurance (45 CFR 80) [unreadable] Assurance Conceming the Handicapped (45 CFR 84) Q Assurance Conceming Sex Discrimination (45 CFR 86) [unreadable] Assurance Conceming Age Discrimination (45 CFR 90 &45 CFR 91). 5. Human Subjects Certification, when applicable (45 CFR 46) D PART B: This part is provided to assure that pertinent information has been addressed and included in the application. YES NOT Applicable 1. Has a Public Health System Impact Statement for the proposed program/project been completed and distributed as required? D 1x1 2. Has the appropriate box been checked on the SF-424 (FACE PAGE) regarding intergovernmental review under E.O. 12372 ? (45 CFR Part 100) 3. Has the entire proposed project period been identified on the SF-424? 4. Have biographical sketch(es) with job description(s) been attached, when required? D 5. Has the "Budget Infonnation" page, SF-424A (Non-Construction Programs) or SF-424C (Construction Programs), been completed and included? 6. Has the 12 month detailed budget been provided? n 7. Has the budget for the entire proposed project period with sufficient detail been provided? 0 n 8. For a Supplemental application, does the detailed budget address only the additional funds requested? D 9. For Competing Continuation and Supplemental applications, has a progress report been included? D D PART C;in the spaces provided below, please provide the requested information. n Business Official to be notified If an award Is to be made Name: Prefix: Dr. [unreadable]First Name: joann Middle Name: U [unreadable]LastName: iBouqhinan I Suffix: IphD Title: [Executive Vice President Organization: Iftmerican Society of Htmian Genetics Address: [unreadable]Streetl 9650 Rockville Pike Street 2: I * City: Isethesda * State: MD: Maryland Province: [unreadable] Country: |usA: UNITED STATES 'Zip / Postal Code: 20814 [unreadable] Teleptione Number. UQ-J^ g34 7309 E-mail Address: Hboughmanigashq.orq Fax Number: 301 634 7079 APPLICANT ORGANIZATION'S 12-DIGIT DHHS EIN (if already assigned) Q 52-1419397 PHS-5161-1 (7/00) PART C (Continued): In the spaces provided below, please provide the requested information. Program DirectorProject Director/Principal Investigator designated to direct the proposed project Name: Prefix: ''[unreadable]First Name: 'Joann 'Middle Name: h Dr. * Last Name: JBoughman I Suffix: I PhD Title: [Executive Vice President Organization: Address: "Streetl: Street2: [unreadable] City: [unreadable] State: 'Country: * Telephone Number: E-mail Address: Fax Number: |american Society of HUman Genetics 9650 Rockville Pike Bethesda MD: Maryland USA: UNITED STATES * Zip / Postal Code: 20814 301 634 7307 jboughmangashq. org 301 634 7079 SOCIAL SECURITY NUMBER HIGHEST DEGREE EARNED 308-50-1523 PhD PART D: A private, nonprofit organization must include evidence of its nonprofit status with the application. Any of the following is acceptable evidence. Checl^ the appropriate box or complete the "Previously Filed" section, whichever is applicable. I-I (a) A reference to the organization's listing in the Internal Revenue Service's (IRS) most recent list of tax-exempt organizations described in section '-'501 (c)(3) of the IRS Code. [X] (b) A copy of a currently valid Internal Revenue Service Tax exemption certificate. ]-I (c) A statement from a State taxing body, State Attorney General, or other appropriate State official certifying that the applicant organization has a '-'nonprofit status and that none of the net earnings accrue to any private shareholders or individuals. I I (d) A certified copy of the organization's certificate of incorporation or similar document if it clearly establishes the nonprofit status of the organization, I-I (e) Any of the above proof fcor a State or national parent organization, and a statement signed by the parent organization that the applicant organization is a local nonprofit affiliate. If an applicant has evidence of current nonprofit status on file witti an agency of PI-IS, it wiii not be necessary to file similar papers again, but the place and date of fiiinq nnusl be indicated. Previously Filed with: '(Agency) on '[unreadable] (Date) INVENTIONS If this is an application for continued support, include: (1) the report of inventions conceived or reduced to practice required by the terms and conditions of the grant;or (2) a list of inventions already reported, or (3) a negative certification. EXECUTIVE ORDER 12372 Effective September 30,1983, Executive Order 12372 (Intergovernmental Review of Federal Programs) directed OMB to abolish OMB Circular A-95 and establish a new process for consulting with State and local elected officials on proposed Federal financial assistance. The Department of Health and Human Services implemented the Executive Order through regulations at 45 CFR Part 100 (Inter-governmental Review of Department of Health and Human Services Programs and Activities). The objectives of the Executive Order are to (1) increase State flexibility to design a consultation process and select the programs it wishes to review, (2) increase the ability of State and local elected officials to influence Federal decisions and (3) compel Federal officials to be responsive to State concems, or explain the reasons. The regulations at 45 CFR Part 100 were published in Federal Register on June 24, 1983, along with a notice identifying the Department's programs that are subject to the provisions of Executive Order 12372. Infonnation regarding PHS programs subject to Executive Order 12372 is also available from the appropriate awarding office. States participating in this program establish State Single Points of Contact (SPOCs) to coordinate and manage the review and comment on proposed Federal financial assistance. Applicants should contact the Govemor's office for infonnation regarding the SPOC, programs selected for review, and the consultation (review) process designed by their State. Applicants are to certify on the face page of the SF-424 (attached) whether the request is for a program covered under Executive Order. 12372 and, where appropriate, whether the State has been given an opportunity to comment. Project Narrative File(s) * IWandatory Project Narrative File Filename: Project Narrative Foriti.pdf Add.Ma^ridatory.PrpieciNarTative:File| peletejMandaltog_^Project:Narrat2ve^^ y'^yy_!^JPJ?J[unreadable]!y.LP!?J?p!:-^[unreadable],r'!^*Ly^.^'^g,} To add more Project Nan^ative File attachments, please use the attachment buttons below. 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